Occ. Code 6803050
ASSISTANT DIRECTOR OF CLAIMS, M-4
DIRECTOR OF CLAIMS, M-5
New York State Department of Civil Service
BRIEF DESCRIPTION OF CLASS
Assistant Directors and Director of Claims oversee claims administration, disability benefits administration, disputed medical bills, rehabilitation counseling and facilities management at the Workers Compensation Board.
ASSISTANT DIRECTOR OF CLAIMS: managerial level; under the general direction of the Director of Claims, supervises Workers Compensation Program Managers 3 within either upstate or downstate regions, coordinates activities of centralized claims programs and statewide workgroups, and serves as a high level technical claims processing expert.
DIRECTOR OF CLAIMS: one-position class; managerial level; directs and oversees the statewide workers compensation claims program and implementation of policy directives; supervises Assistant Directors of Claims.
The Assistant Directors Compensation Claims & Medical Administration and Director Compensation Claims & Medical Administration oversee the New York State Insurance Funds claims and medical administration functions performed in various business offices throughout the State.
Workers Compensation Program Manager 3 functions as district or unit manager supervising Workers Compensation Examiners and clerical staff in regional offices or over statewide functions such as licensing or provider monitoring under the general direction of Assistant Director Claims or similar level position.
Compensation Claims Referees adjudicate claims arising under the Workers Compensation Law, Disability Benefits Law, Volunteer Firefighters Benefits Law, and Volunteer Ambulance Workers Law. They review informal administrative determinations and proposed conciliation decisions; and conduct formal evidentiary hearings and render decisions.
ASSISTANT DIRECTOR OF CLAIMS: Manage staff and new projects studying regionalization and/or centralization of claims processing functions, such as centralized indexing, document control activities, coordination of calendaring/hearing schedules, and coordination of customer service functions including call center development and implementation; participate in Statewide district management meetings and inform executive staff of any issues related to claims operations program areas; advise district claims staff of procedural changes, new procedures, upcoming issues, problems with major insurance carriers, third party administrators, and corporations or businesses; function as a statewide focal point for communication with internal Workers Compensation Board (WCB) offices and the district offices regarding proposed and implemented legislative changes, and review and analyze impact on rules and regulations regarding the potential impact on claims processing, existing procedures ; serve as technical liaison with the Office of Continuous Improvement to formulate, review and approve procedures and reference materials; gather, prepare, and review claims processing performance reports, investigate problems areas, teams, individuals, etc. and interview employees/managers to prepare recommendations; serve as the highest-level technical claims processing expert in the Office of Operations, and acts as an advisor to the Director of Claims in such matters; prepare monthly reports and information for internal and external stakeholders; determine training needs and participate in statewide training efforts; perform the full range of supervisory duties; and preside over hearings in emergency situations.
DIRECTOR OF CLAIMS: direct claims operations and provide direction on the resolution of complex claims issues; represent executive staff in meetings with representatives from other state agencies, private businesses/corporations, insurance carriers, labor and management groups, physicians, and lawyers on claims related issues; serve as the agencys spokesperson and subject matter expert on claims administration, prepare and present public addresses on behalf of executive staff on issues related to the WCB; participate in meetings with other program managers, reporting out on claims issues, progress on new efforts, issues of particular sensitivity, landmark cases, and any problems which need to be brought to the attention of the executive staff and Chair of the WCB; recommend changes in WCB law, rules, regulations, procedures and communications as relevant and necessary to ensure local and statewide claims administration is effective; work closely with other program managers, such as WCB attorneys, to ensure that all related WCB services and efforts are coordinated in order to provide constituents with the most comprehensive resources and educational materials; prepare internal status reports as required, review and approve central claims and district office reports, review recommendations, and adopt as appropriate; prepare budget justification for central office claims staff, provide input for district offices expenditures and resources, monitor financial reports and authorize disbursements; review and approve requests to fill positions as appropriate, adjust staffing plans against workload; oversee all facility related issues, including moves, renovations and redesigns, ensuring smooth business continuity and continuation of operations; direct the disability benefits management function of the WCB; oversee disputed medical bills and ensure that timely decisions are rendered relative to provider submissions for payment; and perform the full range of supervisory duties.
ASSISTANT DIRECTOR OF CLAIMS
Promotion: one year of service as a Workers Compensation Program Manager 3.
DIRECTOR OF CLAIMS
Promotion: one year of service as an Assistant Director of Claims, or two years as a Workers Compensation Program Manager 3.
NOTE: Classification Standards illustrate the nature, extent and scope of duties and responsibilities of the classes they describe. Standards cannot and do not include all of the work that might be appropriately performed by a class. The minimum qualifications above are those which were required for appointment at the time the Classification Standard was written. Please contact the Division of Staffing Services for current information on minimum qualification requirements for appointment or examination.